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Management of reproduction that relies on naturally based solutions is extremely important to counter the negative perception around hormone-based interventions. In Mediterranean latitudes and wider regions of non-tropical drylands, sheep do not normally ovulate during spring but exposure to a ram can induce oestrus and ovulation. This study assesses the response of maiden Barbarine ewes in drylands to the ‘ram effect’ during springtime and estimates the genetic parameters of this response. The study uses a database documenting, for 24 consecutive years, the response of nulliparous 18-month-old ewes when mated after stimulation by the ‘ram effect.’ In addition to the oestrous and fertility database, a pedigree database was also available. Nearly half of the maiden ewes responded to the ‘ram effect,’ while 24% exhibited spontaneous reproductive activity and displayed oestrus during the first 14 days following the introduction of rams. Nearly 5% of females did not exhibit oestrus, and these animals are proposed for early culling. Average annual values of Normalised Difference Vegetation Index (NDVI), reflecting vegetation cover, and the percent of maiden ewes spontaneously cycling were positively correlated (P = 0.006). Interestingly, NDVI was negatively correlated with the percentage of anoestrus females that did not respond to the ‘ram effect’ but exhibited oestrus beyond the hypothetical time frame commonly used to describe it. Average fertility was 82.8% and was significantly affected by mating year, live weight at mating, and the response to the ‘ram effect.’ The highest fertility (88.39%) was for females spontaneously cycling at the time of ram introduction, and the lowest (83.35%) was for females coming into oestrus beyond the time frame for a ram-induced oestrus and ovulation. Heritability from a univariate logit-transformed analysis for fertility was 0.10 and the genetic correlation between fertility and the interval between ram introduction and oestrus was 0.26, suggesting that a shorter interval is associated with higher fertility. Thus, the interval between ram introduction and oestrus is a good candidate for selective breeding for high fertility of maiden ewes in drylands mated out-of-season using the ‘ram effect.’

A 38-year-old man, with no history of malignancy, was found to have a 2 cm jugular lymph node, for which a lymph node tuberculosis was suspected. The specimen revealed a cystic structure lined by mature keratinizing squamous epithelium with a prominent granular cell layer consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. This is the first case report of a rapidly enlarging squamous inclusion cyst in a jugular lymph node. Our case demonstrates the diagnostic challenges related to a squamous inclusion cyst in cervical lymph node and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations.

Management of reproduction that relies on naturally based solutions is extremely important to counter the negative perception around hormone-based interventions. In Mediterranean latitudes and wider regions of non-tropical drylands, sheep do not normally ovulate during spring but exposure to a ram can induce oestrus and ovulation. This study assesses the response of maiden Barbarine ewes in drylands to the 'ram effect' during springtime and estimates the genetic parameters of this response. The study uses a database documenting, for 24 consecutive years, the response of nulliparous 18-month-old ewes when mated after stimulation by the 'ram effect.' In addition to the oestrous and fertility database, a pedigree database was also available. Nearly half of the maiden ewes responded to the 'ram effect,' while 24% exhibited spontaneous reproductive activity and displayed oestrus during the first 14 days following the introduction of rams. Nearly 5% of females did not exhibit oestrus, and these animals are proposed for early culling. Average annual values of Normalised Difference Vegetation Index (NDVI), reflecting vegetation cover, and the percent of maiden ewes spontaneously cycling were positively correlated (P = 0.006). Interestingly, NDVI was negatively correlated with the percentage of anoestrus females that did not respond to the 'ram effect' but exhibited oestrus beyond the hypothetical time frame commonly used to describe it. Average fertility was 82.8% and was significantly affected by mating year, live weight at mating, and the response to the 'ram effect.' The highest fertility (88.39%) was for females spontaneously cycling at the time of ram introduction, and the lowest (83.35%) was for females coming into oestrus beyond the time frame for a ram-induced oestrus and ovulation. Heritability from a univariate logit-transformed analysis for fertility was 0.10 and the genetic correlation between fertility and the interval between ram introduction and oestrus was 0.26, suggesting that a shorter interval is associated with higher fertility. Thus, the interval between ram introduction and oestrus is a good candidate for selective breeding for high fertility of maiden ewes in drylands mated out-of-season using the 'ram effect.', (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive interstitial disease leading to pulmonary damage and respiratory failure. We aimed to investigate the effect of prickly pear molasses (PPM) on an experimental model of pulmonary fibrosis induced by bleomycin (BLM) in Wistar rat. Animals were divided into 5 groups: the control group (G1), the BLM group (G2) and three groups (G3, G4, G5) receiving a single intra-tracheal injection of BLM (4 mg/kg) and PPM (at 2, 4.5 and10 %) that was introduced into the diet one week before BLM injection and continued for 3 weeks. Our phytochemical results revealed significant polyphenol and flavonoid content. LCMS analysis revealed the presence of Sinapinic acid, t-ferulic acid, t-cinnamic acid, Caffeic acid, gallic acid and vallinic acid among others. Our histological study revealed significant decrease in collagen deposition in the groups of rats treated with 4.5 % and 10 % molasses compared to BLM group. Oxidative stress in pulmonary tissues was investigated using catalase (CAT), superoxide dismutase (SOD), and malondialdehyde (MDA) assays. Treatment with PPM normalized the disturbance in the level of these oxidative markers in G3,G4, G5 compared to G2. In conclusion, PPM exhibit antifibrotic and antioxidant activities in BLM model of lung fibrosis., (© 2024 Wiley-VHCA AG, Zurich, Switzerland.)

Introduction: The grading of glial tumors is based on morphological and sometimes on molecular features. Many markers have been assessed in order to grade the glial tumours without a real consensus. Some authors reported that SRSF1, a spiling factor, presents an expression correlated to the tumours grades., Aim: In this study, we aimed to assess the utility of the SRSF1 into the grading of gliomas based on its immunohistochemical expression., Methods: The authors conducted a meta-analysis under the PRISMA guidelines during a 10-year-period (2013-2023). The Meta-Disc software 5.4 (free version) was used. Q test and I2 statistics were carried out to explore the heterogeneity among studies. Meta-regression was performed in case of significant heterogeneity. Publication bias was assessed using the funnel plot test and the Egger's test (free version JASP)., Results: According to the inclusion criteria, 4 studies from 193 articles were included. The pooled SEN, SPE and DOR accounted respectively for 0.592, 0.565 and 1.852. The AUC was estimated to 0.558 suggesting a bad diagnostic accuracy. The heterogeneity in the pooled SEN and SPE was statistically significant. The meta-regression analysis focusing on the technique used, the clones, the dilution, the interpretation technique revealed no covariate factors (P>0.05)., Conclusion: Even if this meta-analysis highlighted the absence of a real diagnostic utility of the SRSF1 in grading the glial tumours, the heterogeneity revealed reinforces the need for more prospective studies performed according to the quality assessment criteria.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Introduction: The evaluation of programs in faculties of medicine enables them to adequately reach their mission objectives, and social responsibilities and to correct their potential lacune. Few publications have described the process of internal evaluation of a program performed by the organizational members. The authors aimed to describe a practical method called the four-axis method to assess curriculum using a practical example., Methods: The authors performed a descriptive study, highlighting the application of a particular method of evaluation of a program called the four-axis method. It consisted of the assessment of the pedagogical alignment [1], teaching techniques and evaluation tests [2], students' viewpoints and needs [3], and the teachers' opinions and needs [4]. To contextualize this method, the authors described a practical experience of the assessment of a multidisciplinary theme (theme 16), which is taught during the second year of medical education. Was performed the evaluation from January 2020 to January 2021. The population studied consisted of the tutors implicated in the teaching of the theme and the students in the second year of medical education who accepted to answer the satisfaction questionnaires. The students and tutors who did not fill out the questionnaires were excluded. No statistical tests were needed because of the descriptive nature of the study., Results: The most relevant results highlighted that 48.4% of the teachers did not systematically use bioclinical cases involving interactions between students; also, 42.4% of the students believed that the teaching sessions didn't introduce practical examples giving rise to interactions between them. Therefore, the 4-axis-based analysis indicated that weaknesses were mostly attributed to the lack of homogeneity in the teaching methods and techniques which showed the teachers' difficulties in integrating clinical data into their teaching so that they can help the students to assimilate the fundamental data., Conclusion: The authors' used a particular approach since it focused both on an objective evaluation of the teaching methods and the evaluation tests and the students' and teachers' viewpoints and needs. The major limitation of this approach was the fact that it could not integrate the educational environment that could impact the students' performances., Competing Interests: The authors declare no conflicts of interest., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

The treatment of Helicobacter pylori infection remains a challenge. None of the proposed treatment regimens has resulted in a 100% eradication rate. The aim of our study was to compare the rate of H. pylori eradication after standard or dose-optimized amoxicillin quadruple therapy. We conducted a prospective comparative study collating patients naive to any anti- H. pylori treatment and with chronic H. pylori infection documented by histological examination. Patients were randomly assigned to either standard quadruple therapy or optimized quadruple therapy. Eradication control was performed by urea breath test. Eighty-eight eligible patients were included with 44 in each group.There was no significant difference between the eradication rates of Qo-14 and Qs-14 neither in ITT (84 vs 70.4%; p = 0.127) nor in PP (82.1 vs 77.7%; p = 0.473). Compliance and tolerance appeared similar in each group., Competing Interests: The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties., (© 2024 Salma Souissi.)

Objective: Idiopathic pulmonary fibrosis (IPF) is the most serious form of interstitial lung disease. We aimed to investigate the effect of Phœnix dactylifera, L. seed oil (DSO) on a murine model of IPF induced by bleomycin (BLM)., Methods: Male Wistar rats were treated with a single intra-tracheal injection of BLM (4 mg/kg) and a daily intraperitoneal injection of DSO (75, 150 and 300 mg/kg) for 4 weeks., Results: Our phytochemical results showed that DSO has an important antioxidant activity with a high content of polyphenols and flavonoids. High-Performance Liquid Chromatography (HPLC) and Gas chromatography/mass spectrometry (GC-MS) analysis revealed a high amount of oleic and lauric acids and a large quantity of vitamins. Histological examination showed a significant reduction in fibrosis score and collagen bands in the group of rats treated with 75 mg/kg of DSO compared to the BLM group. DSO (75 mg/kg) reversed also the increase in catalase and malondialdehyde (MDA) levels while higher doses (150 and 300 mg/kg) are ineffective against the deleterious effects of BLM. We revealed also that DSO has no renal or hepatic cytotoxic effects., Conclusion: DSO can play antioxidant and antifibrotic effects on rat models of pulmonary fibrosis at the lowest dose administered.

Background: The diagnosis of lung cancer is based on the microscopic exam of tissue or liquid. During the recent decade, many biomarkers have been pointed to have a potential diagnostic role. These biomarkers may be assessed in blood, pleural effusion or sputum and they could avoid biopsies or other risky procedures. The authors aimed to assess the diagnostic performances of biomarkers focusing on micro-RNA and metabolites., Methods: This meta-analysis was conducted under the PRISMA guidelines during a nine-year-period (2013-2022). the Meta-Disc software 5.4 (free version) was used. Q test and I 2 statistics were carried out to explore the heterogeneity among studies. Meta-regression was performed in case of significant heterogeneity. Publication bias was assessed using the funnel plot test and the Egger's test (free version JASP)., Results: According to our inclusion criteria, 165 studies from 79 articles were included. The pooled SEN, SPE and dOR accounted, respectively, for 0.76, 0.79 and 13.927. The AUC was estimated to 0.859 suggesting a good diagnostic accuracy. The heterogeneity in the pooled SEN and SPE was statistically significant. The meta-regression analysis focusing on the technique used, the sample, the number of biomarkers, the biomarker subtype, the tumor stage and the ethnicity revealed the biomarker number ( p   =  0.009) and the tumor stage ( p   =  0.0241) as potential sources of heterogeneity., Conclusion: Even if this meta-analysis highlighted the potential diagnostic utility of biomarkers, more prospective studies should be performed, especially to assess the biomarkers' diagnostic potential in early-stage lung cancers., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Skills in critical appraisal of medical literature are compulsory to achieve in medical practice. This step is the third step of the evidence-based medicine process whose main role is to bridge a gap between scientific evidence and practice. Acquiring skills in critical appraisal of the literature has been reported to be challenging for the trainees with different limits according to their levels, backgrounds or specialties., Aim: To assess the limits and factors influencing the practice of appraising literature of different students from the same faculty. This faculty included training of biostatistics and preventive medicine in the curriculum during the first 2 years of medical education without linking this learning to the evidence-based medicine practice., Methods: The authors performed a qualitative study including volunteers who attended voluntarily the same training about critical appraisal of medical literature. The study was based on a satisfaction questionnaire fulfilled by all the participants at the end of the training and on an individual semi-structured interviews programmed 3 months after the training. The satisfaction questionnaire was rated by the authors. The authors proceeded also to a content analysis of the interviews following 3 steps: pre-analysis, treatment of the results, and interpretation., Results: All the participants (95) fulfilled the questionnaire. The satisfaction's mean score revealed a general moderate satisfaction. Eleven students agreed to be interviewed: Five students from the third year of medical education, 2 students from the second year of medical education, 2 postgraduate students and 2 family doctors. The main themes discussed by the interviewees consisted of training organization, the assessment, the impact on research and the impact on the care process., Conclusion: To promote EBM learning, medical students first need to actively participate to interactive learning, introduced early and gradually into the curriculum and integrating all specialties including postgraduate students.

In this study, we aim to investigate the effect of industrial Olea europaea L. leaf extract (OLE) against bleomycin (BLM)-induced pulmonary fibrosis (PF) in rats. Male Wistar rats were treated with a single intratracheal injection of BLM (4 mg/kg) and a daily intraperitoneal injection of OLE (10, 20, and 40 mg/kg) for 4 weeks. Results of HPLC and LC-MS analysis revealed a large amount of oleuropein (15.43%/DW) in OLE. BLM induced apparent damage of lung architecture with condensed collagen bundles, increased lipid peroxidation which has been deduced from malondialdehyde (MDA) levels: (.9 ± .13 vs .25 ± .12 nmol/mg protein) and hydroxyproline content (.601 ± .22 vs .154 ± .139 mg/g of lung tissue) and decreased catalase (CAT) (5.93.10 -5 ± 4.23.10 -5 vs 6.41.10 -4 ± 2.33.10 -4  μmol/min/mg protein) and superoxide dismutase (SOD) (28.73 ± 3.34 vs 50.13 ± 2.1 USOD/min/mg protein) levels compared to the control. OLE treatment (40 mg/kg) stabilized MDA content (.32 ± .15 and .27 ± .13 vs .9 ± .13 nmol/mg protein), normalized SOD (61.27 ± 13.37 vs 28.73 ± 3.34 USOD/min/mg protein), and CAT (5.2.10 -4 ±1.8.10 -4 vs 5.93.10 -5 ± 4.23.10 -5  μmol/min/mg protein) activities and counteracted collagen accumulation and hydroxyproline content (.222 ± .07 vs .601 ± .22 mg/g of lung tissue) in the lung parenchyma. Finally, OLE might have a potent protective effect against PF by regulating oxidative parameters and attenuating collagen deposition, due to the existence of large amount of bioactive phenolic molecules., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Young Patients with lung cancer represent a distinct subset of patients with this neoplasm. Young International studies show increased lung cancer rates in females, while the incidence in males continues to decline. There is evidence to suggest that this trend recurs in younger patients. We studied the effects of gender differences on the incidence of surgical stages of lung cancer in young adults and its mortality rate., Methods: This study is a retrospective review (2010-2020) of young adults (aged under 45 years) with surgical-stage of lung cancer. We calculated female-to-male differences in incidence rate ratios, tumor characteristics, surgical management, and survival. Cumulative survival curves were generated by the Kaplan-Meier method., Results: We examined 46 men and 24 women, under 45 years. Female patients were diagnosed at earlier stages. The proportion of stage IA disease was significantly higher in women than in men (46% versus 13%, respectively) (p=0.03). Women were more likely never smokers (42% versus 83%, p=0.02). A histologic subtype, females were more likely to have typical carcinoid tumors (13.54% versus 10.21% for males) (p>0.05). The largest histological type in men was adenocarcinoma (25.53% versus 4.16%, p>0.05). All the patients were operated. Three men had neoadjuvant chemotherapy and one was operated on for cerebral oligometastatic before his chest surgery. Adjuvant chemotherapy was given to 7 women and 21 men. Despite the small number of postoperative complications in our study (n= 8, 11.2%), the male sex was significant in predicting this complication (p<0.05). The mortality rate was 1.4%. The 5-year overall survival rates were 84% in men and 87% in women., Conclusion: Our study identified sex differences in the incidence and mortality rates for surgical lung cancers in young adults, but the biological and endocrine mechanisms implicated in these disparities have not yet been determined., Competing Interests: The authors declare that they have no competing interests, (© 2023 Abdennadher et al.)

Introduction: Critical appraisal of medical literature is a mandatory skill to practice evidence-based medicine. The relation between the critical appraisal skills and the critical thinking potential has been rarely assessed in the literature., Aim: To assess the relation of critical thinking potential to critical appraisal of medical literature competencies. Besides, they tried to highlight the variation of the critical thinking potential according to the students' level., Methods: The authors conducted a mixed study associating a quantitative and a qualitative approach. The study included second year (SYME), third year (TYME) and postgraduate medical students (CME) and family doctors (FD) from the same faculty of medicine. All the students received the same active training focused on critical appraisal of medical literature. They were asked to fulfil a pre-requisite test and a self-assessment questionnaire before the training session and a final test after the training. The self-assessment questionnaire was conceived by an expert committee and assessed the main characteristics of critical thinking consisting of sensitivity to context, self-correction and search for criteria. Three months after the training, the students were interviewed using a semi-structured interview. The SPSS software 16.0 was used., Results: In our study, 58.9% of the students presented a high critical thinking potential profile. Their scores varied according to their levels with better scores in SYME and FD and intermediate scores in TYME and CME. The pre-requisite test scores varied according to the critical thinking profile and the level. On the other hand, final test scores didn't differ according to the critical thinking profile or the level., Conclusion: Our results put emphasis on the variation of the critical thinking potential according to the students' levels. The better results of the SYME students in comparison to those in the TYME put emphasis on the necessity of changing curriculum in order to enhance the sensitivity and the inclination of the students.

Introduction: Acute appendicitis is a common health problem mainly due to a lumen obstruction. The obstruction is mainly due to fecal material, lymphoid hyperplasia or parasites. Foreign bodies and especially seeds have been rarely reported as causes of acute appendicitis and account for less than 1% of the different causes., Case Report: The authors described a rare case of acute appendicitis caused by seed and causing diagnostic challenge with the most frequent parasites observed in the appendix lumen. Different arguments were gathered to rule out enterobius vermicularis, taenia species, ascaris infection or schistosomiasis., Conclusion: Seed-caused-appendicitis has to be known and identified by pathologists in order to avoid the diagnosis of parasites infection which may induce an overuse of antibiotics after the appendectomy.

Introduction: The diagnosis of malignant pleural mesothelioma (MPM) depends on microscopic examination performed on pleural biopsies taken under thoracoscopy. However, it has recently been established that cytology presents a significant diagnostic contribution enabling an earlier diagnosis with a minimally invasive procedure., Aim: To assess the diagnostic value of consensual cytological features of MPM in the differentiation between adenocarcinoma, mesothelioma and reactive mesothelial cells in pleural liquid., Methods: All available retrospective records from the computerized pathology database system and pathology reports were searched for malignant pleural effusion cytology specimens, over a 5-year period from January 2015 to February 2020. The cytological criteria based on the international Guidelines for cytopathologic diagnosis of epithelioid and mixed type of MPM were assessed. Malignant mesothelial cells, MNML and RL were considered as the gold standard., Results: 189 pleural biopsies with their corresponding cytology specimens were available for review. Among the reviewed cytologies, the diagnoses of 21/189 pleural cytologies were modified. The highest sensitivities were attributed to cytoplasmic blebbing, hypercellularity and cell ball clusters. The most specific feature was the absence of extracellular granular hyaluronic acid cores in reactive cytology and the absence of intercellular openings in NMML cell clusters. Extracellular granular hyaluronic acid cores had the highest positive predictive value and the highest negative predictive value was attributed to the cytoplasmic blebbing in both reactive cytology and NMML., Conclusion: These results highlight the fact that no sign is pathognomonic of the diagnosis of MPM pointing out the necessity of immunocytochemical techniques in equivocal cases.

Using a simple 10 to 20 milliliters of blood sample in order to make the diagnosis of lung cancer is the dream of every patient and practitioner. In fact, even if tissue samples or bronchial liquid represent the gold standard for microscopic diagnosis, using less invasive procedures represented the aim of many researches published in the literature. The utility of biomarkers has been widely reported in screening context, mainly in association to low dose CT-scan, or in therapeutic context in order to highlight therapeutic targets or to change treatment in a context of resistance to target therapies. The use of biomarkers in a diagnostic context has been recently highlighted in the literature. The authors aimed to present a general review of different biomarkers that could be used in the diagnosis of lung cancer.

Background: Lobular capillary hemangioma is a benign vascular tumor commonly found within the skin and upper respiratory mucosa and has rarely been reported within the trachea. The first case was reported by Irani et al. in 2003 and since then, less than 20 cases have been described. That's why the characteristics and treatments remain relatively unknown., Case Presentation: A 53-year-old woman was symptomatic of recurrent episodes of hemoptysis associated with paroxysmal dyspnea. Physical examination, routine blood investigations, and chest x-ray were normal. The flexible bronchoscopy showed a polypoid bleeding lesion arising from the right lateral wall of the middle third of the trachea. Tumor biopsy was not performed considering an eventual bleeding risk. Computed tomography scanning showed a vascular, endotracheal budding tissue process without peritracheal or distant extension. A rigid bronchoscopy was performed for diagnostic and therapeutic purposes. A 10-millimeter bronchoscope was used. A rigid coring technique was performed to remove the tumor. A minimal bleeding was completely controlled after diode laser treatment. There were no complications during or after the procedure. Pathology revealed no malignancy and the diagnosis of lobular capillary hemangioma was confirmed. At a 6-month follow-up, the patient was asymptomatic and the endoscopic control did not show any tumor recurrence., Conclusion: The lobular capillary hemangioma is a benign tumor rarely observed in the trachea. Clinical features are not specific and the short-term prognosis depends on tumor size. Considering its benign nature, tumor removal by interventional bronchoscopy should be proposed as the first-line treatment., (Copyright© 2023 National Research Institute of Tuberculosis and Lung Disease.)

Introduction: Critical appraisal of medical literature is a challenging step of the evidence-based medicine practice. Many assessment questionnaires have been published in the literature, but they have mainly focused on all the evidence-based medicine practice process. The authors aimed to develop and validate a questionnaire assessing the critical appraisal skills of medical students from the same Faculty., Methods: The questionnaire was developed by item generation through a review of the literature and an expert committee. The questionnaire was validated in terms of content validity and construct validity. Fitness of data for analysis was checked through Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity. Construct validity was carried out using a principal axis exploratory factor analysis (EFA) with 'varimax' rotation to study the internal structure of the questionnaire and to extract the test major factors. The questionnaire was administrated to a cohort of under and postgraduate medical students (n=84) to evaluate the test reliability and select the best items. The reliability of the questionnaire was assessed by Cronbach's alpha coefficient to evaluate the internal consistency. The correlations between the self-confidence and satisfaction dimension score, the critical thinking dimension score, the learning style dimension score, the Fresno-adapted test scores and the total score were assessed using the Spearman's correlation test., Results: The questionnaire consisted of 31 items. A factorial analysis grouped the items into 3 dimensions that consisted of the self-confidence and satisfaction dimension, the critical thinking dimension and the learning style dimension. Cronbach's alpha accounted for 0.95, CI95% [0.9-1] for the entire questionnaire. The factor analysis explained 79.51% of the variance. The external validity assessment based on a Spearman's correlation study highlighted a weak correlation between the total scores and the critical thinking dimension and the self-perception and satisfaction dimension., Conclusion: In spite of the limitations of this study, mainly the small number of the students recruited, the questionnaire seems to measure with adequate reliability the competences of under and postgraduate medical students., Competing Interests: None declared., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

Introduction: The tutor's role has been changing in the active learning methods in comparison to the traditional ones. Tutors are encouraged to become facilitators and to guide the students to construct a new knowledge by making bridges with the old one. Tutor's expertise in the active methods has been discussed with different results. The aim of this study was to assess the impact of tutor expertise on the students' scores in active learning methods., Methods: The authors conducted this meta-analysis under the guidelines of a critical tool for systematic reviews (AMSTAR2). PubMed, Embase, Cochrane library, Scopus and Science Direct were the databases used for searching. The articles included compared students' learning scores according to tutor expertise between 2 groups of students with an active method of learning. The Review Manager software 5.3 was used to conduct this meta-analysis. We considered the mean difference as the effect size., Results: 3169 students and 222 learning groups of 5 to 10 students were included in this study. The combined mean difference reached 0.84 with 95% CI [0.22, 1.46]. A significant difference between the two groups was observed in favour of the non-expert group (p=0.008). The heterogeneity I-square was evaluated to 98%. The Funnel plot reflected no publication bias (p=0.21). A sub-group analysis was performed taking into account the studies dealing with medical curriculum and the assessment methods used. It showed a significant difference between the two groups in favour of non-expert tutors (p<0.05)., Conclusion: Even if the results of this meta-analysis couldn't be conclusive and can't induce recommendations, they highlighted the tendency of non-expert tutors to be more student-centred. The heterogeneity observed can be decreased by establishing consensual definitions of expertise and assessment tools in further research studies in order to reflect the validity and efficiency of different tutoring styles in active learning methods., Competing Interests: None declared., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

Introduction: Serious games have been reported to be a valuable method of learning for over a decade., Aim: The authors assessed the efficacy of using a serious games to teach critical appraisal practice to medical students in comparison to face-to-face learning methods., Methods: This was a cluster randomised controlled trial including 3rd year medical students. The control group had to perform a critical appraisal of two articles guided by a checklist, while the intervention group performed a critical appraisal using a home-made serious game. Judgment criteria consisted of the students' scores attributed to their appraisal of a same article after the training period., Results: Twenty-four students in the control and intervention group were enrolled in the study. There was no significant difference in scores between both groups. The satisfaction questionnaire highlighted more motivation and self-accomplishment feeling in the intervention group., Conclusion: This study didn't show a significant difference between the scores of both groups but the motivation of the students included in the intervention group was improved and encourages the use of both methods in critical appraisal teaching.

Introduction: Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor response. Thus, they considerably influence the evolution of cancers including non-small cell lung carcinomas. Even if, this important role is consensual, many discordant results are published in the literature about the prognostic role of the different populations of tumor-infiltrating lymphocytes. The aim of our work was to evaluate the prognostic impact of CD8+, CD4+, and forkhead box protein P3+ lymphocytes in the tumor microenvironment of non-small cell lung carcinomas., Methods: We conducted a retrospective descriptive study, which included non-small cell lung carcinomas diagnosed in the department of pathology and followed in the medical oncology department of the same hospital between 2011 and 2015. Tumor-infiltrating lymphocytes were analyzed by the immunohistochemical method for forkhead box protein P3, CD4, and CD8. Intratumoral and stromal-labeled lymphocytes were quantified by manual counting at high magnification (×400). Forkhead box protein P3+/CD8+, forkhead box protein P3+/CD4+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of tumor-infiltrating lymphocytes was assessed in respect of overall survival, recurrence-free survival, and relapse-free survival., Results: Thirty-nine patients were included. The mean age of patients was 59.6 years. A complete surgical resection ( p  = 0.009), and a CD8/CD4 ratio ( p  = 0.008) were prognostic factors for overall survival. Complete surgical resection ( p  = 0.003), the forkhead box protein P3/CD8 ( p  = 0.005), and forkhead box protein P3/CD4 ( p  = 0.037) ratios were prognostic factors for recurrence-free survival. The CD8+ tumor-infiltrating lymphocytes rate ( p  = 0.037) was a prognostic factor for relapse-free survival with a threshold of 67.8/high power field. Microscopic subtype ( p  = 0.037) was a prognostic factor for relapse-free survival when only adenocarcinoma and squamous cell carcinoma were considered. In multivariate analysis, age ( p  = 0.004) and a CD8/CD4 ratio ( p  = 0.016) were independent predictors of overall survival., Conclusion: Despite the limitations of our study, our results confirm the prognostic value of tumor-infiltrating lymphocytes in non-small cell lung carcinomas and the importance of the combined quantification of their different subpopulations.

Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating and fatal disease characterized by aberrant fibroblasts proliferation, oxidative stress and collagen accumulation in the interstitial tissue. We aimed to evaluate in the present study the efficacy of Thymus vulagris extract (TVE) on an experimental model of pulmonary fibrosis induced by bleomycin (BLM). Wistar rats were given a single dose of BLM (4 mg/kg, intratracheal), while TVE (50, 100 and 200 mg/kg, intraperitoneal) was administered 3 days later and continued for 4 weeks. We reveled by HPLC analysis an important amount of phenolic bioactive compounds such as rosmarinic and vanillic acids. Our results showed a significant decrease of catalase and superoxide dismutase activities and an increase in lipid peroxidation compared to control group after BLM injection. Treatment with TVE (200 mg/kg) was able to normalize the level of these oxidative markers and to decrease collagen accumulation compared to BLM group. Moreover, this high dose of TVE have no renal or hepatic cytotoxic effects. This study allowed us to conclude that thyme extract has a strong antioxidant and antifibrotic activities due to its high content of polyphenols.